Agoraphobia Treatment: Break the Fear Habit

Agoraphobia is a very treatable problem, once you understand how it
works. Agoraphobia treatment based on cognitive behavioral methods is
the most effective treatment method available.

Two Tasksof Agoraphobia Treatment

Agoraphobia treatment consists of two principal tasks. The first is
learning how to respond to panic attacks, and the anticipatory fears of a
panic attack, in ways that will reduce the severity of the problem over
time. This may seem obvious, but most people get tricked by panic into trying to fight it off or hold it at bay, rather than working with it. These efforts will make the problem worse, rather than better.

The second recovery task, once the first has been achieved, is to
begin entering those situations you have come to avoid in order to get
some practice using your newly learned responses in actual situations
that you fear.This is what's called, in cognitive behavioral treatment, exposure.

Agoraphobia is actually a very treatable problem, yet all too
often, people find themselves struggling to make progress in ways that
actually hinder their recovery. This is usually due to a common
misunderstanding about the nature of agoraphobia treatment with exposure
methods.

A Common Misunderstanding

Let's suppose you have panic attacks in large grocery stores, and
you've been working hard to overcome this. You've learned some breathing
techniques, and more or less understand that, even though you get very
afraid in grocery stores, nothing terrible is likely to happen to you as
a result. So you resolve to start practicing with grocery stores.

You might have the idea that exposure means going to the grocery store and not
having a panic attack. So you grab a few items from the front displays,
pay at the express register, and quickly leave, grateful that you
didn't have a full blown panic attack. Or maybe you talk with friends on
your cell phone while you shop in an effort to distract yourself from
thoughts of panic.

This is a common misunderstanding, so common that even some
professional therapists will encourage their patients to follow this
approach. It misses the point of exposure therapy, and will likely make
your recovery more difficult.

The point of exposure practice is not to enter into a feared
situation, like a grocery store, and not have a panic attack. That would
be like going to a self defense class but refusing to practice sparring
with your classmates. The point of the practice is to have some
experience with panic symptoms. You do it a step at a time, at a pace
that's acceptable to you, but always aiming to practice with the panic.

In Agoraphobia treatment with exposure therapy
methods, the point is to expose yourself to the panic itself. Exposure
isn't aimed at the grocery store, or the highway, or the crowded
theater. We just go there in order to have the experience of feeling
panic. That's the point of exposure. Expose yourself to the panic
itself, and practice working with those feelings so that you can lose
your fear of fear.

Instead of relying on safety behaviors, such as avoidance and distraction, a person learns how to manage a panic attack. By this, I mean a person learns to accept and work with the panic, rather than against it. This is what Claire Weekes called "floating".

How will this help?

Let's suppose there was a movie that you found particularly scary and
unpleasant. Let's also pretend that there was a big reward, maybe
$50,000, if you could watch the movie without feeling afraid. I don't
mean just pretending that you're not afraid. That won't get you
the reward money, because the people running the contest will hook you
up to all kinds of sensors that will monitor your pulse, blood pressure,
respiration, and so on. To win this prize, you have to become unafraid.
How might you do it?

I don't know of any such contest, but if there ever is one, I
know what I'll do. I'll rent the DVD and watch that movie 24/7 for
several days, until it bores me to tears. That would be the
surest way.

This is the essential element of agoraphobia treatment. You
practice with the situations and the sensations, and allow them to
become boring. (As my wife likes to point out, I get paid to bore
people).

This approach asks you to work with, rather than against,
something you despise. It probably goes against your natural instincts,
and so it takes some getting used to. But it's well worth the effort,
for it's the surest way out of the problem of agoraphobia. My Panic Attacks Workbook offers you a step by step guide to this process.